Urinary Incontinence


Identify whether symptoms suggestive of  1) Stress incontinence (SUI)

      2) Overactive bladder (OAB) and urge incontinence

      3) Mixed Incontinence (SUI and OAB)

Consider using the Bladder Symptom Profile/Bladder Diary in the link here (https://www.cornwallft.nhs.uk/bladder-and-bowel-service/) over minimum of 3 days

Consider and treat

·       UTI

·       pelvic mass

·       neurological problems

·       medication effects

·       constipation

·       atrophic vaginitis

·       obesity

·       fluid intake

·       chronic cough



·       Urinalysis

·       Assess pelvic floor muscle contraction using Muscle Grading System

(0 = no contraction, 1 = flicker, 2 = weak, 3 = moderate, 4 = good (with lift), 5 = strong)

·       Arrange a bladder pre/post voiding ultrasound scan if :

- Symptoms suggestive of voiding dysfunction

  (hesitancy, Poor stream, Straining, Incomplete emptying, terminal dribbling) OR

            - Recurrent UTI

Red flags

·       Micro (60yrs+) & macro (45yrs+) haematuria – 2ww urology referral

·       Recurrent UTI with haematuria (40yrs+)- 2ww referral urology

·       Suspected pelvic mass - 2ww gynae if suspected malignancy 



Pelvic Floor Exercises:

Bladder Re-Training;

Referral for supervised PFE to the pelvic floor nurses.


NOTE in women with mixed ui start both conservative/medical treatments for SUI and OAB 

Patient lead Pelvic Floor Exercises (PFE) advice: https://www.yourpelvicfloor.org/conditions/pelvic-floor-exercises/

Bladder Re-training advice: https://yourpelvicfloor.org/conditions/bladder-training


Bladder and Bowel Service: bladderandbowelspecialistenquiries@nhs.net


References: NICE Guideline [NG123] Publish date: 02 April 2019 Last Updated: 24 June 2019

Author:Dr S Burns GP

Contributors:Farah Lone, Consultant Uro-gynaecologist RCHT


Date:January 2022

Review date: December 2023